Full Name
*
Email
*
Phone
*
Are you legally authorized to work in the United States?
*
Yes
No
Are you at least 18 years old?
*
Yes
No
Do you have a valid driver’s license?
*
Yes
No
Do you have reliable transportation to and from clients’ homes?
*
Yes
No
Are you willing to undergo a background check and drug screening?
*
Yes
No
Do you have prior experience working as a caregiver or in a healthcare setting?
*
Yes
No
Have you ever worked with clients who have dementia or Alzheimer’s disease?
*
Yes
No
Are you trained in CPR and First Aid?
Yes
No
Are you comfortable assisting clients with bathing, dressing, and toileting?
*
Yes
No
Are you able to prepare meals and perform light housekeeping tasks?
Yes
No
Are you available to work weekends if needed?
Yes
No
Are you available for overnight or live-in shifts?
Yes
No
Are you looking for full-time employment?
Yes
No
Can you start work immediately if hired?
Yes
No
Are you willing to travel to different client locations within the area?
*
Yes
No
Do you consider yourself patient and compassionate?
Yes
No
Can you follow written and verbal care plans accurately?
*
Yes
No
Are you comfortable communicating with family members and supervisors?
Yes
No
Do you handle stressful situations calmly and professionally?
Yes
No
Are you willing to participate in caregiver training and continuing education?
Yes
No